Chemical Analysis and Tests.—These have been described on [p. 339 et seq.]
Treatment.—The stomach pump should be used without delay, and the stomach thoroughly washed out. The washing water should contain about ten to fifteen grains of permanganate of potash to the pint, and the washing repeated at short intervals, as the permanganate destroys the morphine. If the stomach tube be not at hand, the patient should be made to drink the permanganate solution if possible. This treatment should be carried out even when morphine has been administered hypodermically, as it is excreted by the stomach. Emetics should also be given if the patient can swallow; if unable to do so, a hypodermic of ⅒ grain of apomorphine may be given. The administration of strong coffee or tea, the application of ammonia to the nostrils, flagellation of the soles of the feet, and keeping the patient constantly walking about (a procedure of doubtful value) are among the measures usually adopted by way of treatment. Galvanism and artificial inflation of the lungs have done good service even in the most hopeless cases. The student is referred to some important cases recorded by Dr. Burgess and others in the Medical Press and Circular, vol. i. p. 369, for the year 1892. Dr. Burgess strongly recommends prolonged artificial respiration, the interrupted current, and the administration of stimulants, externally, internally, and hypodermically. Dr. Finny is of opinion that, while opium may be useful in cases of atropine poisoning, atropine is of little use in opium poisoning; in this opinion Dr. Burgess concurred. The state of the respiration is a better test than the condition of the pupil when atropine is used as an antidote. If the administration of atropine does not quicken the respiration it should be discontinued, and other methods tried. Vinegar should not be given, as it dissolves the morphine and renders it more easy of absorption. Death is rare in those cases in which proper remedies have been resorted to before the stage of stupor has commenced.
Synopsis of the Effects of Opium
upon the System
1. The Mental Faculties.—The first effect noticed when opium is taken in small doses is a primary exaltation of the mental faculties; the imagination is rendered brilliant, and the passions exalted; after a time drowsiness supervenes, followed by deep sleep. A dose of thirty drops of the tincture caused in one experimenter an exhilaration of the mental faculties, and an aptitude for study; the subsequent drowsiness being removed by a dose of a hundred drops or more, when the greatest mental excitement was the result.
2. The Respiration.—The frequency of the respiration is diminished, and the oxidation of the blood impaired.
3. The Pulse.—The first effect on the circulatory system is that of a stimulant, and then sedative. By the administration of repeated small doses, the force of the circulation may be maintained for some time.
4. The Eyes and Countenance.—The pupils, when the patient is powerfully under the influence of opium, are contracted even to a point. Dilatation, has, however, been noticed in some cases, especially when death approaches. In apoplexy of the pons Varolii, the pupils are contracted. The countenance is placid, pale, and ghastly; the eyes heavy, and the lips livid.
5. The Cutaneous System.—The skin, although cold, is not infrequently bathed in profuse perspiration.
6. The Alimentary Canal.—Sometimes there is vomiting and even purging; but, as a rule, the secretions along the whole alimentary canal are diminished, and constipation is the result. According to Dr. Walter Smith, of Dublin, morphine is mainly excreted into the stomach and bowels, and so cast out in the fæces. Very little goes out in the urine.
7. The Average Commencement of Symptoms.—Much depends upon the size and form of the dose. In most cases the first appearance of the symptoms is seldom delayed beyond an hour after the poison is taken.